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A Guide To Health Insurance In Mexico

Lovely weather, friendly people, rich culture, scenic beauty, and modern infrastructure are just a few of the traits that make the vibrant country of Mexico a highly popular destination with expatriates from across Europe and North America. Many people move to this nation just to take advantage of its excellent healthcare services, which are easily available at affordable prices.Introduction to Healthcare in Mexico

The standard or healthcare across Mexico is very high. Each of the cities have at least one world-class medical facility as well as a network of private clinics and public hospitals. There are about 4,450 healthcare institutions, of which 67% belong to the private sector and 33% are a part of the public sector. Moreover, a majority of the medics have received at least some part of their training in America, Canada or Europe. Getting in touch with a doctor who speaks fluent English is therefore quite easy. Your local consulate should be able to help you with a list of medical professionals that can speak your language. This means that users are getting almost the same quality and service as they would in the US or UK. However, they end up paying a lot less than they would in those countries.

Many people in Mexico, especially expats, prefer opting for private healthcare even though the public facilities are fairly good, mainly to avoid long waiting times. While the medical services of both the sectors are on par with each other, public hospitals offer only basic accommodation and meals to their patients. Relatives may not be permitted to stay with the patients in most cases. At times, some of the public setups ask a patient to move to a private facility because they have limited resources and equipment. It is also important to note that long-term or expensive treatments are not covered by the public system.

Private healthcare is of a higher quality but it comes at a premium cost. This is because they usually offer a variety of luxuries such as a television, an air-conditioner in the room, an extra bed for a relative, and basic necessities (like towels and toiletries). In fact, many private clinics ask the patients to bring along a helper, who can provide personalized assistance with bathroom visits, feeding or simply just fluffing the pillows. Unfortunately, people who do not have a private health insurance cover cannot usually afford private healthcare.

Funding of Healthcare in Mexico

The entire National Health System falls under the regulation of the Ministry of Health (Secretaria de Salud). At the same time, the individual states all have their own autonomous health services, which are known as Servicios Estatales De Salud (SESA). These too are regulated by the Ministry of Health. This entity is of paramount importance in Mexico as it is in charge of providing medical care to those people who are not covered under health insurance. Seguro Popular de Salud is a fund that has been set up by the Ministry for those who cannot afford healthcare services.

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As per the labor laws of this country, it is compulsory for all employers and employees to contribute towards the social security fund and in return, they receive access to the Public Health Service. This is also applicable to foreigners who are working and living in Mexico. An employee has the right to choose from a couple of institutions, depending on the sector they work in. The most prominent Social Security Institutions in this country are the Mexican Social Security Institute or Instituto Mexicano de Seguro Social (for employees working in the private sector) and Instituto de Seciridad y Servisios Sociales de los Trabajadores Del Estado or ISSTE (for public sector employees).

As an expat living in Mexico, you have the right to receive medical treatment under the IMSS program but only if the organization that you are working for gets you registered for the service. Registering for it individually is not a good idea, considering how complicated the entire process is. The documents that you will require include:

• A valid passport
• Work permit proof
• Proof of residence
• Birth certificate (which has been translated into Spanish)
• Marriage certificate (only if applicable)
• Disclosure of your medical history and preexisting conditions (questionnaire as well as reports)

One of the main benefits of registering with IMSS is that it covers you for healthcare services as well as salary payments in case of an illness or a major accident.

Once you are accepted into the program, a card will be issued to you. Make sure that you carry the card for all your visits to the doctor.

The federal government subsidizes public healthcare costs partially, or in some instances, entirely. Like in most other nations, public hospitals in Mexico offer low-cost treatments to people who do not have insurance cover.

If you have health insurance, you can be reimbursed for part of your medical expenses (usually up to 80%), depending upon the terms and conditions of your policy. However, you will need to make the payment upfront for the charges of any service that you use and can file for a claim later.

Health Insurance in Mexico

As an expat, it is important for you to carefully think about investing in a solid health insurance plan for yourself as well as your family members, before you move to any foreign country. Moreover, regardless of your nationality and the purpose of your visit, you will be expected to have travel insurance cover when you enter Mexico.

Do keep in mind that a majority of the medical facilities in Mexico don’t accept international health insurance when it comes to treating residents. Any health service or treatment covered by the US-based Medicare system will not be available in this country. In case of hospitalization, you will have to make the full payment before being discharged from the hospital. You can then get the relevant paperwork from that clinic to file for an insurance claim. The whole reimbursement procedure could take more than a month.

Many American citizens apply for an international health insurance policy with their local providers before moving overseas, just so that they can be covered in two countries, or preferably worldwide. Unfortunately, Mexico does not have any kind of healthcare agreements with other nations. The medical system neither provides any free treatment to outsiders, nor recognizes policies that were issued by a company overseas. It is therefore best that you apply for cover with a health insurance company in Mexico.

If your insurance provider back home claims to be valid overseas, check if there is a limit on the duration for which you are covered. Some of the questions that you should ask before arriving are:

• Does the policy specifically include Mexico?
• What are the toll-free numbers in Mexico, with English-speaking operators for assistance under the plan?
• Which hospitals and clinics are included in the network?
• Will the plan cover any specialist care or specific requirements?
• What are the limitations and additional fees that you should expect?

If you are working and are registered with the IMSS, you will have health insurance (for treatment at public hospitals) through social security. However, if you are not a part of the universal healthcare system, it is important to apply for private health insurance without delay.

A majority of the expats living and working in Mexico are covered by the IMSS through their employers, but at the same time, most of them also have a private insurance plan. Those who can afford it and need it sign up for health insurance with a couple of private local and international companies.

When applying for private health insurance, you will have to decide between a comprehensive plan and a catastrophic one. Most prefer a comprehensive cover as it takes care of not just major medical costs but also the smaller expenses, such as doctors’ visits and prescription drugs.

The premium charged by the insurance company will vary based on the extent of cover you choose. Some of the other factors that will also have an impact on your premiums include your age, medical history, lifestyle and potential health risks. You could end up paying anywhere between Mexican Pesos 21,500 (US $ 1100) and Mexican Pesos 390,300 (US $ 20,000) per year, depending on the company you sign up with. It is therefore best to check for coverage plans and premiums with at least 3 to 4 organizations before deciding on one.

At times, some of the health insurance companies apply certain restrictions on the type of hospital you can seek treatment at in order to reimburse your expenses. It is therefore best to get a list of facilities that your provider has an agreement with before taking any decision.

A number of insurance companies in Mexico have agreements with medical facilities so that their customers do not have to make a payment when they get discharged. However, the general norm is for people to pay the hospital bill when they are released. They then file for a reimbursement claim by filling out forms and submitting the required invoices. Of course, this includes a lot of paperwork, which could get a little complicated, especially if you are not very familiar with the language. To avoid any errors, you could go through an insurance agent, who will guide you on the timelines and documents to be submitted for a fee.

In Mexico, some of the health insurance companies have restrictions on the types of injuries and accidents they will pay for. Your plan may not include an injury that is considered a result of a “hazardous activity”, even if it doesn’t appear dangerous to you. These facts should also be looked at in detail, before signing up for anything.

Health Insurance Companies

You will easily be able to find several firms offering private insurance covers to individuals and families at competitive rates. Some of the most prominent players in this industry are:

GNP Seguros
Mexicali – Blvd. Benito Juárez No. 1295, Col. Jardines del Valle, CP 21270, Mexicali, Baja California.
Tijuana – Diego Rivera Ave. No. 1511, Esq. Paseo de los Héroes, Col. Zona del Rio, CP 22320, Tijuana, Baja California
Tel: 1 800 400 9000
URL: https://www.gnp.com.mx

Royal and Sun Alliance
Blvd. Adolfo López Mateos No. 2448 Colonia Altavista, Delegation Álvaro Obregón, Mexico City, Mexico. CP 01060
Tel: 1 800 911 7692/ 01 55 5723 7944
URL: https://www.royalsun.com.mx/

Tel: 1 800 00 METLIFE (Interior of the Republic)/ 5328 7000 (Metropolitan area)
URL: http://www.metlife.com.mx

Tower DKV, Avda. María Zambrano, 31, 50018, Zaragoza (Headquarters)
Tel: 1 902 499 499/ 1 902 499 600
URL: http://dkvseguros.com/

Please note that most of the sites listed above are in Spanish but can be translated to English. You should also be able to chat with a representative online, if you wish to do so.

It may come as a surprise to learn that a number of Mexican banks also offer health insurance products to their customers, as part of their service portfolio. Before you sign up with them, go through the fine print carefully since their plans tend to be quite limited.

Pharmacies and Medication

It is important to note that while the overall costs of healthcare services in Mexico are relatively low as compared to other places, certain medicines can actually be a lot more expensive than what you are used to. The good news is that pharmacies are plentiful all over the country, even in the smaller towns. You should be able to easily purchase any over-the-counter and prescription drugs at any time of day. If you are on any specific medication, a good health insurance cover plan can help you save a significant amount of money.

Soon after you make the move to Mexico, speak to experts about the kind of insurance plan you should opt for, based on your requirements.

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